Healthcare Provider Details

I. General information

NPI: 1093886319
Provider Name (Legal Business Name): T.P. WEAVER & SONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N TEXAS ST
DE LEON TX
76444-1857
US

IV. Provider business mailing address

124 N TEXAS ST
DE LEON TX
76444-1857
US

V. Phone/Fax

Practice location:
  • Phone: 254-893-6496
  • Fax: 254-893-5341
Mailing address:
  • Phone: 254-893-6496
  • Fax: 254-893-5341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number00528
License Number StateTX

VIII. Authorized Official

Name: MR. SAM EUGENE WEAVER JR.
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 254-893-6496